Erratum: Measurement of the 2νββ Decay Half-Life of ^{130}Te with CUORE [Phys. Rev. Lett. 126, 171801 (2021)]

This corrects the article DOI: 10.1103/PhysRevLett.126.171801.

Generation of the iPSC line FINi002-A from a male Parkinson's disease patient carrying compound heterozygous mutations in the PRKN gene

The most common cause of autosomal recessive familial Parkinson's disease (PD) are mutations in the PRKN/PARK2 gene encoding an E3 ubiquitin protein-ligase PARKIN. We report the generation of an iPSC cell line from the fibroblasts of a male PD patient carrying a common missense variant in exon 7 (p.Arg275Trp), and a 133 kb deletion encompassing exon 8, using transiently-present Sendai virus. The established line displays typical human primed iPSC morphology and expression of pluripotency-associated markers, normal karyotype without SNP array-detectable copy number variations and can give rise to derivatives of all three embryonic germ layers. We envisage the usefulness of this iPSC line, carrying a common and well-studied missense mutation in the RING1 domain of the PARKIN protein, for the elucidation of PARKIN-dependent mechanisms of PD using in vitro and in vivo models.

Measurement of the 2νββ Decay Rate and Spectral Shape of ^{100}Mo from the CUPID-Mo Experiment

Neutrinoless double beta decay (0νββ) is a yet unobserved nuclear process that would demonstrate Lepton number violation, a clear evidence of beyond standard model physics. The process two neutrino double beta decay (2νββ) is allowed by the standard model and has been measured in numerous experiments. In this Letter, we report a measurement of 2νββ decay half-life of ^{100}Mo to the ground state of ^{100}Ru of [7.07±0.02(stat)±0.11(syst)]×10^{18}  yr by the CUPID-Mo experiment. With a relative precision of ±1.6% this is the most precise measurement to date of a 2νββ decay rate in ^{100}Mo. In addition, we constrain higher-order corrections to the spectral shape, which provides complementary nuclear structure information. We report a novel measurement of the shape factor ξ_{3,1}=0.45±0.03(stat)±0.05(syst) based on a constraint on the ratio of higher-order terms from theory, which can be reliably calculated. This is compared to theoretical predictions for different nuclear models. We also extract the first value for the effective axial vector coupling constant obtained from a spectral shape study of 2νββ decay.

Tritium Beta Spectrum Measurement and Neutrino Mass Limit from Cyclotron Radiation Emission Spectroscopy

The absolute scale of the neutrino mass plays a critical role in physics at every scale, from the subatomic to the cosmological. Measurements of the tritium end-point spectrum have provided the most precise direct limit on the neutrino mass scale. In this Letter, we present advances by Project 8 to the cyclotron radiation emission spectroscopy (CRES) technique culminating in the first frequency-based neutrino mass limit. With only a cm^{3}-scale physical detection volume, a limit of m_{β}<155  eV/c^{2} (152  eV/c^{2}) is extracted from the background-free measurement of the continuous tritium beta spectrum in a Bayesian (frequentist) analysis. Using ^{83m}Kr calibration data, a resolution of 1.66±0.19  eV (FWHM) is measured, the detector response model is validated, and the efficiency is characterized over the multi-keV tritium analysis window. These measurements establish the potential of CRES for a high-sensitivity next-generation direct neutrino mass experiment featuring low background and high resolution.

Post-TB health and wellbeing

TB affects around 10.6 million people each year and there are now around 155 million TB survivors. TB and its treatments can lead to permanently impaired health and wellbeing. In 2019, representatives of TB affected communities attending the '1st International Post-Tuberculosis Symposium´ called for the development of clinical guidance on these issues. This clinical statement on post-TB health and wellbeing responds to this call and builds on the work of the symposium, which brought together TB survivors, healthcare professionals and researchers. Our document offers expert opinion and, where possible, evidence-based guidance to aid clinicians in the diagnosis and management of post-TB conditions and research in this field. It covers all aspects of post-TB, including economic, social and psychological wellbeing, post TB lung disease (PTLD), cardiovascular and pericardial disease, neurological disability, effects in adolescents and children, and future research needs.

New Direct Limit on Neutrinoless Double Beta Decay Half-Life of ^{128}Te with CUORE

The Cryogenic Underground Observatory for Rare Events (CUORE) at Laboratori Nazionali del Gran Sasso of INFN in Italy is an experiment searching for neutrinoless double beta (0νββ) decay. Its main goal is to investigate this decay in ^{130}Te, but its ton-scale mass and low background make CUORE sensitive to other rare processes as well. In this Letter, we present our first results on the search for 0νββ decay of ^{128}Te, the Te isotope with the second highest natural isotopic abundance. We find no evidence for this decay, and using a Bayesian analysis we set a lower limit on the ^{128}Te 0νββ decay half-life of T_{1/2}>3.6×10^{24}  yr (90% CI). This represents the most stringent limit on the half-life of this isotope, improving by over a factor of 30 the previous direct search results, and exceeding those from geochemical experiments for the first time.

820 Machine learning significantly improves neoantigen-HLA predictions utilizing > 26,000 data points from the PACTImmuneTM Database

Background

PACT Pharma has developed a state-of-the-art approach to validate predicted neoepitopes (neoEs) and their cognate T cell receptors (neoTCRs) by capturing neoepitope-specific T cells from peripheral blood. This neoTCR discovery and validation process is being applied in clinical trial (NCT03970382) evaluating personalized neoTCR-T cell therapy to treat patients across eight solid tumor types. Extensive pre-, on- and post-treatment data related to this trial has been accumulated in the PACTImmune Database (PIDB) which represents a growing data asset for patient-specific tumor immunogenicity in solid tumors. Here we present a specific use case of applying machine learning (ML) to significantly improve neoE-HLA predictions and further model anticipated improvements of TCR capture as a direct consequence.

Methods

PACT has developed capabilities for high-throughput manufacturing of single polypeptide (comPACT protein) which consists of the predicted neoE peptide together with Beta-2-Microglobulin and the HLA heavy chain. comPACT molecules are considered successfully produced when protein yields reach concentrations >1uM. Data used for this study consisted of >26000 neoE-HLA predictions for 62 different HLA alleles. We applied ML to learn patterns that are predictive of neoE-HLAs that can be successfully produced as comPACTs, using scikit-learn and XGBoost. Data was first split into training and testing data. Models were trained on training data and model hyperparameters were tuned using 5-fold cross validation (5xCV). The performance of the models during 5xCV and on test data was measured using the area under the receiver operating characteristic curve (AUC). We additionally performed experimental prospective validation of the models. To do this, 603 neoE-HLAs (from 7 previously unseen cancer samples) were selected for comPACT production using netMHCpan4.1 and the newly trained models.

Results

The mean AUC for the 5xCV of the selected models ranged from 0.75 to 0.86 depending upon the HLA allele (SD <0.05 for every model). The AUC on the test data ranged from 0.75 to 0.92 (median = 0.85). Prospective validation resulted on average in a 22% higher success rate (range 11%–39%) using the new models as compared to the netMHCpan4.1 predictions. This is expected to result in increased capture of neoepitope-specific CD8+ T cells as the PIDB indicates that 3.2% of the successful comPACTs result in validated neoTCRs.

Conclusions

PIDB based ML predictions of neoE-HLAs led to a significant increase in TCR-capturing comPACT success rates. Because of this work, it is predicted both neoE-specific CD8+ T cell capture and actionable neoTCR options will increase per patient.

Abstract 2177: Tumor neoantigen profiling with validated patient-specific TCR characterization to improve neoepitope prediction

PACT Pharma has developed an ultra-sensitive approach to validate predicted neoantigens and the cognate T cell receptors (neoTCRs) from tumor specific somatic mutations by capturing neoantigen-specific T cells from peripheral blood. This process is used in clinical trials (NCT03970382) of personalized neoTCR-T therapy for persons with solid cancers.

Using the state of the art prediction pipeline and screening process, more than one hundred twenty neoantigens were predicted from 5 type of solid cancers that were validated by characterizing cognate T cells and their close to 200 unique TCRs captured from the blood of the same individual. These validated neoepitopes of 8 to 11 amino acids represent broad HLA class I coverage with &gt;30 alleles to date. Our analysis revealed that mutations can occur in all positions within the epitopes. Epitope immunogenicity is potentially affected by different mechanisms including mutation position, agretopicity, as well as HLA interacting positions and/or by interactions between mutated residues and its cognate TCRs. It was observed that these validated neoepitopes comprise broad ranges of predicted HLA binding affinities, stability, and neoantigen expression levels. The analysis presented here offers insights to enable machine learning to advance rules for epitope selection and prioritization that may be important for immunological approaches to address a broad range of diseases, including cancer.

Citation Format: Zheng Pan, Olivier Dalmas, Songming Peng, Kyle Jacoby, Barbara Sennino, Yan Ma, Chad Smith, Amin Momin, Allison Xu, Katharine Heeringa, Jonathan Johnston, Duo An, Boi Quach, William Lu, Diana Nguyen, Andrew Conroy, Bhamini Purandare, Eva Huang, Eric Stawiski, Alex Franzusoff, Stefanie Mandl. Tumor neoantigen profiling with validated patient-specific TCR characterization to improve neoepitope prediction [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2177.

New Limit for Neutrinoless Double-Beta Decay of ^{100}Mo from the CUPID-Mo Experiment

The CUPID-Mo experiment at the Laboratoire Souterrain de Modane (France) is a demonstrator for CUPID, the next-generation ton-scale bolometric 0νββ experiment. It consists of a 4.2 kg array of 20 enriched Li_{2}^{100}MoO_{4} scintillating bolometers to search for the lepton-number-violating process of 0νββ decay in ^{100}Mo. With more than one year of operation (^{100}Mo exposure of 1.17  kg×yr for physics data), no event in the region of interest and, hence, no evidence for 0νββ is observed. We report a new limit on the half-life of 0νββ decay in ^{100}Mo of T_{1/2}>1.5×10^{24}  yr at 90% C.I. The limit corresponds to an effective Majorana neutrino mass ⟨m_{ββ}⟩<(0.31-0.54)  eV, dependent on the nuclear matrix element in the light Majorana neutrino exchange interpretation.

Measurement of the 2νββ Decay Half-Life of ^{130}Te with CUORE

We measured two-neutrino double beta decay of ^{130}Te using an exposure of 300.7 kg yr accumulated with the CUORE detector. Using a Bayesian analysis to fit simulated spectra to experimental data, it was possible to disentangle all the major background sources and precisely measure the two-neutrino contribution. The half-life is in agreement with past measurements with a strongly reduced uncertainty: T_{1/2}^{2ν}=7.71_{-0.06}^{+0.08}(stat)_{-0.15}^{+0.12}(syst)×10^{20}  yr. This measurement is the most precise determination of the ^{130}Te 2νββ decay half-life to date.

Economic evaluation of whole genome sequencing for pathogen identification and surveillance - results of case studies in Europe and the Americas 2016 to 2019

Background

Whole genome sequencing (WGS) is increasingly used for pathogen identification and surveillance.

Aim

We evaluated costs and benefits of routine WGS through case studies at eight reference laboratories in Europe and the Americas which conduct pathogen surveillance for avian influenza (two laboratories), human influenza (one laboratory) and food-borne pathogens (five laboratories).

Methods

The evaluation focused on the institutional perspective, i.e. the ‘investment case’ for implementing WGS compared with conventional methods, based on costs and benefits during a defined reference period, mostly covering at least part of 2017. A break-even analysis estimated the number of cases of illness (for the example of Salmonella surveillance) that would need to be avoided through WGS in order to ‘break even’ on costs.

Results

On a per-sample basis, WGS was between 1.2 and 4.3 times more expensive than routine conventional methods. However, WGS brought major benefits for pathogen identification and surveillance, substantially changing laboratory workflows, analytical processes and outbreaks detection and control. Between 0.2% and 1.1% (on average 0.7%) of reported salmonellosis cases would need to be prevented to break even with respect to the additional costs of WGS.

Conclusions

Even at cost levels documented here, WGS provides a level of additional information that more than balances the additional costs if used effectively. The substantial cost differences for WGS between reference laboratories were due to economies of scale, degree of automation, sequencing technology used and institutional discounts for equipment and consumables, as well as the extent to which sequencers are used at full capacity.

PD-1 inhibition in malignant melanoma and lack of clinical response in chronic lymphocytic leukemia in the same patients: a case series

Chronic lymphocytic leukemia (cll) is the most common adult leukemia in the Western world. Unfortunately, affected patients are often immunosuppressed and at increased risk of infection and secondary malignancy. Previous meta-analysis has found that patients with cll have a risk of melanoma that is increased by a factor of 4 compared with the general population. Recent advances in the understanding of the PD receptor pathway have led to immunotherapies that target cancer cells. The use of PD-1 inhibitors is now considered first-line treatment for BRAF wild-type metastatic melanoma. Interestingly, early preclinical data suggest that inhibition of that pathway could also be used in the treatment of cll; however, recent clinical data did not support the effectiveness of that approach. In this case series, we highlight 2 cases in which patients with cll and concurrent malignant melanoma underwent treatment with PD-1 inhibitors and were found to experience reductions in their white blood cell counts without improvement in their hemoglobin. Those cases further illustrate that treatment of cll with PD-1 inhibitors is ineffective.

Improved Limit on Neutrinoless Double-Beta Decay in ^{130} Te with CUORE

We report new results from the search for neutrinoless double-beta decay in ^{130} Te with the CUORE detector. This search benefits from a fourfold increase in exposure, lower trigger thresholds, and analysis improvements relative to our previous results. We observe a background of (1.38±0.07)×10^{-2}  counts/(keV kg yr)) in the 0νββ decay region of interest and, with a total exposure of 372.5 kg yr, we attain a median exclusion sensitivity of 1.7×10^{25}  yr. We find no evidence for 0νββ decay and set a 90% credibility interval Bayesian lower limit of 3.2×10^{25}  yr on the ^{130} Te half-life for this process. In the hypothesis that 0νββ decay is mediated by light Majorana neutrinos, this results in an upper limit on the effective Majorana mass of 75-350 meV, depending on the nuclear matrix elements used.

Progression of chronic kidney disease and the risk of tuberculosis: an observational cohort study

<sec id="st1"> <title>BACKGROUND</title> Little is known about tuberculosis (TB) risk in the earlier stages of chronic kidney disease (CKD). </sec> <sec id="st2"> <title>OBJECTIVE</title> To investigate the relationship between CKD at all stages and the risk of incident TB. </sec> <sec id="st3"> <title>METHODS</title> We conducted a cohort study using 100 058 participants of a community-based health screening programme in northern Taiwan, 2005-2008. Renal function was ascertained at baseline using serum creatinine level and the urine dipstick test. The occurrence of active TB was ascertained using the National Tuberculosis Registry. Cox proportional hazards regression was used to estimate the association between CKD and TB. </sec> <sec id="st4"> <title>RESULTS</title> During a median follow-up of 7.5 years, TB incidence was 472. In the Cox regression analyses, individuals with Stage 1-4 CKD had a 25% increase in TB hazard than those without disease (adjusted hazard ratio [aHR] 1.25, 95%CI 1.02-1.54). A positive correlation between CKD stage and TB was observed (P = 0.02 for trend). TB risk increased by 5.1% with every 10 ml/min/1.73 m² decrease in the estimated glomerular filtration rate (aHR 1.05, 95%CI 0.99-1.12). </sec> <sec id="st5"> <title>CONCLUSIONS</title> Our results suggested an increased risk of TB in early-stage CKD. TB prevention efforts should consider individuals with earlier stages of CKD. </sec>.

Comparison of routine field epidemiology and whole genome sequencing to identify tuberculosis transmission in a remote setting

Yukon Territory (YT) is a remote region in northern Canada with ongoing spread of tuberculosis (TB). To explore the utility of whole genome sequencing (WGS) for TB surveillance and monitoring in a setting with detailed contact tracing and interview data, we used a mixed-methods approach. Our analysis included all culture-confirmed cases in YT (2005-2014) and incorporated data from 24-locus Mycobacterial Interspersed Repetitive Units-Variable Number of Tandem Repeats (MIRU-VNTR) genotyping, WGS and contact tracing. We compared field-based (contact investigation (CI) data + MIRU-VNTR) and genomic-based (WGS + MIRU-VNTR + basic case data) investigations to identify the most likely source of each person's TB and assessed the knowledge, attitudes and practices of programme personnel around genotyping and genomics using online, multiple-choice surveys (n = 4) and an in-person group interview (n = 5). Field- and genomics-based approaches agreed for 26 of 32 (81%) cases on likely location of TB acquisition. There was less agreement in the identification of specific source cases (13/22 or 59% of cases). Single-locus MIRU-VNTR variants and limited genetic diversity complicated the analysis. Qualitative data indicated that participants viewed genomic epidemiology as a useful tool to streamline investigations, particularly in differentiating latent TB reactivation from the recent transmission. Based on this, genomic data could be used to enhance CIs, focus resources, target interventions and aid in TB programme evaluation.

Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study

BACKGROUND

Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery.

METHODS

This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy.

RESULTS

Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI.

CONCLUSIONS

After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.

Whole genome sequencing for improved understanding of Mycobacterium tuberculosis transmission in a remote circumpolar region

Few studies have used genomic epidemiology to understand tuberculosis (TB) transmission in rural and remote settings - regions often unique in history, geography and demographics. To improve our understanding of TB transmission dynamics in Yukon Territory (YT), a circumpolar Canadian territory, we conducted a retrospective analysis in which we combined epidemiological data collected through routine contact investigations with clinical and laboratory results. Mycobacterium tuberculosis isolates from all culture-confirmed TB cases in YT (2005-2014) were genotyped using 24-locus Mycobacterial Interspersed Repetitive Units-Variable Number of Tandem Repeats (MIRU-VNTR) and compared to each other and to those from the neighbouring province of British Columbia (BC). Whole genome sequencing (WGS) of genotypically clustered isolates revealed three sustained transmission networks within YT, two of which also involved BC isolates. While each network had distinct characteristics, all had at least one individual acting as the probable source of three or more culture-positive cases. Overall, WGS revealed that TB transmission dynamics in YT are distinct from patterns of spread in other, more remote Northern Canadian regions, and that the combination of WGS and epidemiological data can provide actionable information to local public health teams.

Cognitive, physical, and mental health outcomes between long-term cannabis and tobacco users

INTRODUCTION

Cannabis intoxication adversely affects health, yet persistent effects following short-term abstinence in long-term cannabis users are unclear. This matched-subjects, cross-sectional study compared health outcomes of long-term cannabis and long-term tobacco-only users, relative to population norms.

METHODS

Nineteen long-term (mean 32.3years of use, mean age 55.7years), abstinent (mean 15h) cannabis users and 16 long-term tobacco users (mean 37.1years of use, mean age 52.9years), matched for age, educational attainment, and lifetime tobacco consumption, were compared on measures of learning and memory, response inhibition, information-processing, sustained attention, executive control, and mental and physical health.

RESULTS

Cannabis users exhibited poorer overall learning and delayed recall and greater interference and forgetting than tobacco users, and exhibited poorer recall than norms. Inhibition and executive control were similar between groups, but cannabis users had slower reaction times during information processing and sustained attention tasks. Cannabis users had superior health satisfaction and psychological, somatic, and general health than tobacco users and had similar mental and physical health to norms whilst tobacco users had greater stress, role limitations from emotional problems, and poorer health satisfaction.

CONCLUSIONS

Long-term cannabis users may exhibit deficits in some cognitive domains despite short-term abstinence and may therefore benefit from interventions to improve cognitive performance. Tobacco alone may contribute to adverse mental and physical health outcomes, which requires appropriate control in future studies.

Genetic analysis of groups of mid-infrared predicted fatty acids in milk

The objective of this study was to investigate genetic variability of mid-infrared predicted fatty acid groups in Canadian Holstein cattle. Genetic parameters were estimated for 5 groups of fatty acids: short-chain (4 to 10 carbons), medium-chain (11 to 16 carbons), long-chain (17 to 22 carbons), saturated, and unsaturated fatty acids. The data set included 49,127 test-day records from 10,029 first-lactation Holstein cows in 810 herds. The random regression animal test-day model included days in milk, herd-test date, and age-season of calving (polynomial regression) as fixed effects, herd-year of calving, animal additive genetic effect, and permanent environment effects as random polynomial regressions, and random residual effect. Legendre polynomials of the third degree were selected for the fixed regression for age-season of calving effect and Legendre polynomials of the fourth degree were selected for the random regression for animal additive genetic, permanent environment, and herd-year effect. The average daily heritability over the lactation for the medium-chain fatty acid group (0.32) was higher than for the short-chain (0.24) and long-chain (0.23) fatty acid groups. The average daily heritability for the saturated fatty acid group (0.33) was greater than for the unsaturated fatty acid group (0.21). Estimated average daily genetic correlations were positive among all fatty acid groups and ranged from moderate to high (0.63-0.96). The genetic correlations illustrated similarities and differences in their origin and the makeup of the groupings based on chain length and saturation. These results provide evidence for the existence of genetic variation in mid-infrared predicted fatty acid groups, and the possibility of improving milk fatty acid profile through genetic selection in Canadian dairy cattle.

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine: Brussels, Belgium. 15-18 March 2016

[This corrects the article DOI: 10.1186/s13054-016-1208-6.].

Patella bone density is lower in knee osteoarthritis patients experiencing moderate-to-severe pain at rest

OBJECTIVE

To determine differences in patellar subchondral bone mineral density (BMD) between knee osteoarthritis (OA) patients with differing levels of pain at rest.

METHODS

The preoperative knee of 41 total knee replacement (TKR) patients was scanned using QCT and scored for pain using Western Ontario McMasters Osteoarthritis Index (WOMAC). 'Pain at rest' was defined as average pain while lying//sitting and nocturnal pain. Participants were divided into groups: 'mild-to-no pain at rest' and 'moderate-to-severe pain at rest'. We used a depth-specific CT-based mapping technique to measure patellar subchondral BMD at depths of 0-2.5 mm, 2.5-5 mm, and 5-7.5 mm from the subchondral surface. Mean lateral and medial facet BMD were compared between groups using MANCOVA.

RESULTS

Mean adjusted BMD was lower in participants with 'moderate-to-severe pain at rest' over the total lateral facet at depths of 0-2.5 mm (10% lower, p=0.041), 2.5-5 mm (20% lower, p=0.017), and 5-7.5 mm (25% lower, p=0.004), and over the total medial facet at 2.5-5 mm (22% lower, p=0.033) and 5-7.5 mm (28% lower, p=0.016).

CONCLUSIONS

In OA patients with 'moderate-to-severe pain at rest', depth-specific density measures demonstrated up to 28% lower lateral and medial subchondral BMD. Patients with high levels of pain at rest may have reduced amounts of native bone prior to TKR.

An open-label expanded-access trial of bendamustine in patients with rituximab-refractory indolent non-Hodgkin lymphoma or previously untreated chronic lymphocytic leukemia: BEND-ACT

BACKGROUND

Bendamustine is a bifunctional alkylating agent with unique properties that distinguish it from other agents in its class. Bendamustine is used as monotherapy or in combination with other agents to treat patients with non-Hodgkin lymphoma (nhl) and chronic lymphocytic leukemia (cll).

METHODS

The prospective interventional open-label bend-act trial evaluated bendamustine in patients with rituximab-refractory indolent nhl (inhl) and previously untreated cll. Study objectives were to assess the safety and tolerability of bendamustine monotherapy and to provide patients with access to bendamustine before Health Canada approval. The study aimed to enrol up to 100 patients. All patients with inhl received an intravenous dose of bendamustine 120 mg/m(2) over 60 minutes on days 1 and 2 for up to eight 21- or 28-day treatment cycles. All patients with cll received an intravenous dose of bendamustine 100 mg/m(2) over 30 minutes on days 1 and 2 for up to six 28-day treatment cycles.

RESULTS

Of 90 patients treated on study (16 with cll and 74 with inhl), 35 completed the study (4 with cll and 31 with inhl). The most common treatment-emergent adverse events (teaes) were nausea (70%), fatigue (57%), vomiting (40%), and diarrhea (33%)-mostly grades 1 and 2. Ondansetron was the most common supportive medication used in the patients (63.5% of those with inhl and 68.8% of those with cll). Neutropenia (32%), anemia (23%), and thrombocytopenia (21%) were the most frequent hematologic teaes, with neutropenia being the most common grade 3 or 4 teae leading to dose modification. Dose delays occurred in 28 patients (31.3%) because of grade 3 or 4 teaes, with a higher incidence of dose delays being observed in inhl patients on the 21-day treatment cycle than in those on the 28-day treatment cycle (50.0% vs. 24.1%). During the study, 33 patients (36.7%) experienced at least 1 serious adverse event, and 4 deaths were reported (all in patients with inhl).

CONCLUSIONS

The type and frequency of the teaes reported accorded with observations in earlier clinical trials and post-marketing experiences, thus confirming the acceptable and manageable safety profile of bendamustine.

Low effectiveness of seasonal influenza vaccine in preventing laboratory-confirmed influenza in primary care in the United Kingdom: 2014/15 mid–season results

In 2014/15 the United Kingdom experienced circulation of influenza A(H3N2) with impact in the elderly. Mid-season vaccine effectiveness (VE) shows an adjusted VE of 3.4% (95% CI: ?44.8 to 35.5) against primary care consultation with laboratory-confirmed influenza and ?2.3% (95% CI: ?56.2 to 33.0) for A(H3N2). The low VE reflects mismatch between circulating viruses and the 2014/15 northern hemisphere A(H3N2) vaccine strain. Early use of antivirals for prophylaxis and treatment of vulnerable populations remains important.

Publish or perish: strategies to help rural early career researchers increase publication output

INTRODUCTION

Researchers are challenged to publish or perish. A range of barriers to writing can result in sub-optimal productivity, particularly for early career researchers. Researchers in rural areas may face additional challenges of distance and limited access to colleagues. Implementing strategies to address some of these obstacles was identified as a priority for a group of early career, rural researchers.

METHODS

In late 2010, the Wiljo-Piri Writing Group was established, embarking on fortnightly lunch-time meetings for support, networking and the public setting of writing goals; and arranging pairing of 'writing buddies' committed to writing daily, with contact before and/or after each writing session to provide motivation and accountability. Key measures for improvement were publication output (publications per person per year (PPY)) and perceptions of effectiveness of strategies.

RESULTS

Publication output varied between individuals and over time; overall PPY rates improved from 0.5 to 1.25. 'Buddy writing' helped facilitate adherence to routine writing sessions and was associated with perceptions of increased creativity, efficiency, confidence and ability to focus.

CONCLUSIONS

Structured peer support can be a powerful tool to create and maintain regular writing practices and increase publication output. 'Buddy writing' is applicable to any research or academic setting, and helps maintain commitment to daily writing sessions. Furthermore, such interventions can provide peer support for those working in rural settings, helping to address issues such as geographical and professional isolation. Suggested key steps in establishing structured peer support are provided.

Imputation of genotypes from low density (50,000 markers) to high density (700,000 markers) of cows from research herds in Europe, North America, and Australasia using 2 reference populations

Combining data from research herds may be advantageous, especially for difficult or expensive-to-measure traits (such as dry matter intake). Cows in research herds are often genotyped using low-density single nucleotide polymorphism (SNP) panels. However, the precision of quantitative trait loci detection in genome-wide association studies and the accuracy of genomic selection may increase when the low-density genotypes are imputed to higher density. Genotype data were available from 10 research herds: 5 from Europe [Denmark, Germany, Ireland, the Netherlands, and the United Kingdom (UK)], 2 from Australasia (Australia and New Zealand), and 3 from North America (Canada and the United States). Heifers from the Australian and New Zealand research herds were already genotyped at high density (approximately 700,000 SNP). The remaining genotypes were imputed from around 50,000 SNP to 700,000 using 2 reference populations. Although it was not possible to use a combined reference population, which would probably result in the highest accuracies of imputation, differences arising from using 2 high-density reference populations on imputing 50,000-marker genotypes of 583 animals (from the UK) were quantified. The European genotypes (n=4,097) were imputed as 1 data set, using a reference population of 3,150 that included genotypes from 835 Australian and 1,053 New Zealand females, with the remainder being males. Imputation was undertaken using population-wide linkage disequilibrium with no family information exploited. The UK animals were also included in the North American data set (n=1,579) that was imputed to high density using a reference population of 2,018 bulls. After editing, 591,213 genotypes on 5,999 animals from 10 research herds remained. The correlation between imputed allele frequencies of the 2 imputed data sets was high (>0.98) and even stronger (>0.99) for the UK animals that were part of each imputation data set. For the UK genotypes, 2.2% were imputed differently in the 2 high-density reference data sets used. Only 0.025% of these were homozygous switches. The number of discordant SNP was lower for animals that had sires that were genotyped. Discordant imputed SNP genotypes were most common when a large difference existed in allele frequency between the 2 imputed genotype data sets. For SNP that had ≥ 20% discordant genotypes, the difference between imputed data sets of allele frequencies of the UK (imputed) genotypes was 0.07, whereas the difference in allele frequencies of the (reference) high-density genotypes was 0.30. In fact, regions existed across the genome where the frequency of discordant SNP was higher. For example, on chromosome 10 (centered on 520,948 bp), 52 SNP (out of a total of 103 SNP) had ≥ 20% discordant SNP. Four hundred and eight SNP had more than 20% discordant genotypes and were removed from the final set of imputed genotypes. We concluded that both discordance of imputed SNP genotypes and differences in allele frequencies, after imputation using different reference data sets, may be used to identify and remove poorly imputed SNP.

Perspectives on family health, happiness and harmony (3H) among Hong Kong Chinese people: a qualitative study

Family harmony, an important Confucian ideal in Chinese society is believed to determine family happiness and therefore health, but is this accurate? This is a qualitative study of 41 Hong Kong Chinese family members. Individual recorded interviews were thematically analysed describing perceived interactions between harmony, happiness and health. Family harmony comprised four components: communication, mutual respect, lack of conflict and family time [notably 'Gou tong' (in Cantonese )-opportunity and willingness to spend time together-requiring good interpersonal communication, emphasized by female respondents]. Lack of conflict was emphasized, while diverse values, parenting styles and financial difficulties were common causes of conflict. Respect required reciprocity. Family happiness comprised four elements: family harmony, an important pre-requisite; mutual caring and supportive orientation; sense of security emphasizing financial security in middle-class versus sense of togetherness in lower social class groups and contentment. Healthy families were harmonious; 'typical' (children/two-parent/two-grandparent); happy; caring and respectful, with individual health and healthy behaviours. Family harmony, happiness and health are interrelated and built on a communicative, respectful, caring and contented set of attitudes, in particular allowing for family time. Harmony is apparently a core element of good family functioning.

Exertional heat stroke: clinical significance and practice indications for special operations medics and providers

Exertional heat stroke is an acute injury associated with high morbidity and mortality, and is commonly encountered within military and Special Operations environments. With appropriate planning, rapid diagnosis, and aggressive treatment significant mortality reduction can be obtained. Planning for both training and real world operations can decrease the patient?s morbidity and mortality and increase the chances of successful handling of a patient with exertional heat stroke. The mainstay of treatment is rapid reduction of the core body temperature. This is paramount both at the field level of care as well as in a clinical setting. Diligent surveillance for commonly encountered complications includes anticipating electrolyte abnormalities, rhabdomyolysis, acute renal failure, and hepatic injuries. Treatment with dantrolene may be indicated in patients with continued hyperthermia despite aggressive traditional treatment.